Healthcare Provider Details

I. General information

NPI: 1457952012
Provider Name (Legal Business Name): KENTUCKY RECOVERY LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 S 3RD ST
LOUISVILLE KY
40214-2601
US

IV. Provider business mailing address

5115 S 3RD ST
LOUISVILLE KY
40214-2601
US

V. Phone/Fax

Practice location:
  • Phone: 502-690-1511
  • Fax:
Mailing address:
  • Phone: 502-690-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH NALLEY
Title or Position: CEO
Credential:
Phone: 502-690-1511